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AVERY GRACE MACINTOSH
NPI 1609633510
Physician Assistant in Mahtomedi, MN

Active since March 06, 2024PECOS EnrolledAccepts Medicare Assignment
1040 SUMMIT AVE, MAHTOMEDI, MN 55115(651) 815-3171 Get Directions Write a Review

NPPES record last updated: March 6, 2024. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Avery Grace Macintosh NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AVERY GRACE MACINTOSH (NPI 1609633510) is an individual physician assistant in Mahtomedi, Minnesota and active in the NPI registry since March 2024. She is enrolled in Medicare PECOS, is affiliated with St Lukes Regional Medical Center, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1609633510
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameAVERY GRACE MACINTOSH
Location Address1040 SUMMIT AVEMahtomedi, MN 55115-1544
Mailing Address1040 Summit AveMahtomedi, MN 55115-1544 · (651) 815-3171
Phone(651) 815-3171
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateMarch 6, 2024
NPPES CertifiedMarch 6, 2024
✔ NPI 1609633510 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
1040 SUMMIT AVE, Mahtomedi, MN 55115
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Avery Grace Macintosh is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3678052750
PECOS Enrollment IDI20260209003611
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Lukes Regional Medical Center

Acute Care Hospitals · Sioux City, IA
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number160146
Location2720 Stone Park BoulevardSioux City, IA 51104 · Woodbury County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55115 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.82 typical visit price
range $56.00 – $168.28
Typical copayment $21.45 (range $14.00 – $42.07)
Most-billed visit code 99203
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Avery Macintosh's NPI number?

The NPI number for Avery Macintosh is 1609633510. It was assigned to this individual provider in the NPPES registry on March 6, 2024.

Where is Avery Macintosh located?

Avery Macintosh practices at 1040 Summit Ave, Mahtomedi, MN 55115. The listed phone number is (651) 815-3171.

What is Avery Macintosh's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Avery Macintosh enrolled in Medicare?

Yes. Avery Macintosh is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Avery Macintosh affiliated with any hospitals?

According to CMS data, Avery Macintosh is affiliated with St Lukes Regional Medical Center.

When was this NPI record last updated?

The NPPES record for Avery Macintosh was last updated on March 6, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.